, Volume 51, Issue 2, pp 535–561 | Cite as

Fertility Decline, Girls’ Well-being, and Gender Gaps in Children’s Well-being in Poor Countries

  • Kathryn M. YountEmail author
  • Sarah Zureick-Brown
  • Nafisa Halim
  • Kayla LaVilla


The influences of recent dramatic declines in fertility on girls’ and boys’ well-being in poorer countries are understudied. In panels of 67–75 poorer countries, using 152–185 Demographic and Health Surveys spanning 1985–2008, we examined how declining total fertility and women’s increasing median age at first birth were associated with changes in girls’ well-being and gender gaps in children’s well-being, as reflected in their survival, nutrition, and access to preventive healthcare. In adjusted random-effects models, these changes in fertility were associated with gains in girls’ survival at ages 1–4 years, vaccination coverage at ages 12–23 months, and nutrition at 0–36 months (for women’s later first childbearing). Declining total fertility was associated with similar gains for boys and girls with respect to vaccination coverage but intensified gender gaps in mortality at ages 1–4 years and malnutrition at ages 0–36 months, especially in higher-son-preference populations. Later increases in women’s median age at first birth—reflecting more equitable gender norms—were associated with declines in these gaps. Promoting equitable investments in children through family planning programs in higher-fertility societies is warranted.


Cross-national time series Demographic and Health Surveys Fertility trends Gender gaps in well-being Girls’ well-being 



The authors thank the International Center for Research on Women (ICRW) and the Hewlett Foundation for their support. We also warmly thank members and consultants of the Fertility and Empowerment Research Network of ICRW for helpful comments on prior versions of this article. We especially thank Drs. Keera Allendorf, Sajeda Amin, Anju Malhotra, Karen Mason, and Amy Tsui. We also thank Ms. Emily Misch and Ms. Kimi Sato for their assistance with data preparation, and Ms. Francine Pope for assistance with manuscript preparation. This article was drafted while Drs. Nafisa Halim and Sarah Zureick-Brown were post-doctoral fellows and Ms. Kayla LaVilla was a Masters of Public Health student in the Hubert Department of Global Health, Rollins School of Public Health at Emory University. Any remaining errors are the responsibility of the authors.


  1. Adamchak, D. J., & Ntseane, P. G. (1992). Gender, education, and fertility: A cross-national analysis of sub-Saharan African nations. Sociological Spectrum, 12, 167–182.CrossRefGoogle Scholar
  2. Andersson, G., Rønsen, M., Knudsen, L. B., Lappegård, T., Neyer, G., Skrede, K., . . . Vikat, A. (2009). Cohort fertility patterns in the Nordic countries. Demographic Research, 20(article 14), 313–352. doi: 10.4054/Dem.Res.2009.20.14
  3. Barber, N. (2004). Sex ratio at birth, polygyny, and fertility: A cross-national study. Social Biology, 51, 71–77.Google Scholar
  4. Basu, A. M. (1999). Fertility decline and increasing gender imbalance in India, including a possible South Indian turnaround. Development and Change, 30, 237–263.CrossRefGoogle Scholar
  5. Becker, G. S., Duesenberry, J. S., & Okun, B. (1960). An economic analysis of fertility. In G. B. Roberts (Ed.), Demographic and economic change in developed countries (pp. 225–256). Cambridge, MA: National Bureau of Economic Research.Google Scholar
  6. Becker, G. S., & Lewis, H. G. (1973). On the interaction between the quantity and quality of children. The Journal of Political Economy, 81, S279–S288.CrossRefGoogle Scholar
  7. Bongaarts, J. (2008). Fertility transitions in developing countries: Progress or stagnation? Studies in Family Planning, 39, 105–110.CrossRefGoogle Scholar
  8. Brewster, K. L., & Rindfuss, R. R. (2000). Fertility and women’s employment in industrialized nations. Annual Review of Sociology, 26, 271–296.CrossRefGoogle Scholar
  9. Bryant, J. (2007). Theories of fertility decline and the evidence from development indicators. Population and Development Review, 33, 101–127.CrossRefGoogle Scholar
  10. Caldwell, J. C., Orubuloye, I. O., & Caldwell, P. (1992). Fertility decline in Africa: A new type of transition? Population and Development Review, 18, 211–242.CrossRefGoogle Scholar
  11. Chung, W., & Das Gupta, M. (2007). The decline of son preference in South Korea: The roles of development and public policy. Population and Development Review, 33, 757–783.CrossRefGoogle Scholar
  12. Cogill, B. (2003). Anthropometric indicators measurement guide. Washington, DC: Food and Nutrition Technical Assistance (FANTA) Project.Google Scholar
  13. Conde-Agudelo, A., Rosas-Bermudez, A., Castaño, F., & Norton, M. H. (2012). Effects of birth spacing on maternal, perinatal, infant, and child health: A systematic review of causal mechanisms. Studies in Family Planning, 43, 93–114.CrossRefGoogle Scholar
  14. Croll, E. (2000). Endangered daughters: Discrimination and development in Asia. London, UK: Routledge.Google Scholar
  15. Das Gupta, M. (1987). Selective discrimination against female children in rural Punjab, India. Population and Development Review, 13, 77–100.CrossRefGoogle Scholar
  16. Das Gupta, M., & Bhat, M. P. N. (1997). Fertility decline and increased manifestation of sex bias in India. Population Studies, 51, 307–315.CrossRefGoogle Scholar
  17. Das Gupta, M., & Shuzhuo, L. (1999). Gender bias in China, South Korea, and India 1920–1990: Effects of war, famine, and fertility decline. Development and Change, 30, 619–652.CrossRefGoogle Scholar
  18. De, P., & Bhattacharya, B. N. (2002). Determinants of child immunization in four less-developed states of North India. Journal of Child Health, 6(1), 34–50.CrossRefGoogle Scholar
  19. Dorius, S. F. (2008). Global demographic convergence? A reconsideration of changing intercountry inequality in fertility. Population and Development Review, 34, 519–537.CrossRefGoogle Scholar
  20. Dorius, S. F., & Firebaugh, G. (2010). Trends in global gender inequality. Social Forces, 88, 1941–1968.CrossRefGoogle Scholar
  21. Dyson, T. (2001). A partial theory of world development: The neglected role of the demographic transition in the shaping of modern society. International Journal of Population Geography, 7, 1–24.CrossRefGoogle Scholar
  22. Dyson, T. (2012). Causes and consequences of skewed sex ratios. Annual Review of Sociology, 38, 443–461.CrossRefGoogle Scholar
  23. Dyson, T., & Moore, M. (1983). On kinship structure, female autonomy, and demographic behavior in India. Population and Development Review, 9, 35–60.CrossRefGoogle Scholar
  24. Economic and Social Research Council, Research Group on Wellbeing in Developing Countries. (2007). Wellbeing and international development. Bath, England: University of Bath.Google Scholar
  25. Engelhardt, H., & Prskawetz, A. (2004). On the changing correlation between fertility and female employment over space and time. European Journal of Population/Revue Européenne de Démographie, 20, 35–62.CrossRefGoogle Scholar
  26. Engelhardt, H., Kögel, T., & Prskawetz, A. (2004). Fertility and women’s employment reconsidered: A macro-level time-series analysis for developed countries, 1960–2000. Population Studies, 58, 109–120.CrossRefGoogle Scholar
  27. Firebaugh, G. (1999). Empirics of world income inequality. American Journal of Sociology, 104, 1597–1630.CrossRefGoogle Scholar
  28. Firebaugh, G. (2003). The new geography of global income inequality. Cambridge, MA: Harvard University Press.Google Scholar
  29. Folbre, N. (1983). Of patriarchy born: The political economy of fertility decisions. Feminist Studies, 9, 261–284.CrossRefGoogle Scholar
  30. Fox, K., & Heaton, T. M. (2012). Child nutritional status by rural/urban residence: A cross-national analysis. The Journal of Rural Health, 28, 380–391.CrossRefGoogle Scholar
  31. Frejka, T., Jones, G. W., & Sardon, J.-P. (2010). East Asian childbearing patterns and policy developments. Population and Development Review, 36, 579–606.CrossRefGoogle Scholar
  32. Frejka, T., & Sardon, J.-P. (2006). First birth trends in developed countries: Persisting parenthood postponement. Demographic Research, 15(article 6), 147–180. doi: 10.4054/DemRes.2006.15.6 CrossRefGoogle Scholar
  33. Fuse, K. (2010). Variations in attitudinal gender preferences for children across 50 less-developed countries. Demographic Research, 23(article 36), 1031–1048. doi: 10.4054/DemRes.2010.23.36
  34. Fuse, K., & Crenshaw, E. M. (2006). Gender imbalance in infant mortality: A cross-national study of social structure and female infanticide. Social Science & Medicine, 62, 360–374.CrossRefGoogle Scholar
  35. Goesling, B., & Firebaugh, G. (2004). The trend in international health inequality. Population and Development Review, 30, 131–146.CrossRefGoogle Scholar
  36. Gough, I., McGregor, J. A., & Camfield, L. (2007). Theorizing wellbeing in international development. In I. Gough & J. A. McGregor (Eds.), Wellbeing in developing countries: From theory to research (pp. 1–44). Cambridge, MA: Cambridge University Press.CrossRefGoogle Scholar
  37. Grant, M. J., & Behrman, J. R. (2010). Gender gaps in educational attainment in less developed countries. Population and Development Review, 36, 71–89.CrossRefGoogle Scholar
  38. Haider, B. A., Yakoob, M. Y., & Bhutta, Z. A. (2011). Effect of multiple micronutrient supplementation during pregnancy on maternal and birth outcomes. BMC Public Health, 11(Suppl. 3), S19. doi: 10.1186/1471-2458-11-S3-S19 CrossRefGoogle Scholar
  39. Hair, J. F., Anderson, R. E., Tatham, R. L., & Black, W. C. (1995). Multivariate data analysis. Upper Saddle River, NJ: Prentice Hall.Google Scholar
  40. Hanushek, E. A. (1992). The trade-off between child quantity and quality. The Journal of Political Economy, 100, 84–117.CrossRefGoogle Scholar
  41. Hausman, J. A. (1978). Specification tests in econometrics. Econometrica, 46, 1251–1271.CrossRefGoogle Scholar
  42. Heaton, R. B., Froste, R., Hoffmann, J. P., & Flake, D. (2005). Cross-national variation in family influences on child health. Social Science & Medicine, 60, 97–108.CrossRefGoogle Scholar
  43. Hill, K. (1992). Fertility and mortality trends in the developing world. Ambio, 21, 79–83.Google Scholar
  44. Hill, K., & Upchurch, D. M. (1995). Gender differences in child health: Evidence from the Demographic and Health Surveys. Population and Development Review, 21, 127–151.CrossRefGoogle Scholar
  45. Huber, J. (1991). Macro-micro links in gender stratification. In J. Huber (Ed.), Macro-micro linkages in sociology (pp. 11–25). Newbury Park, CA: Sage Publications.Google Scholar
  46. Hull, T. (1990). Recent trends in sex ratios at birth in China. Population and Development Review, 16, 63–83.CrossRefGoogle Scholar
  47. Imdad, A., & Bhutta, Z. A. (2011a). Effect of balanced protein energy supplementation during pregnancy on birth outcomes. BMC Public Health, 11(Suppl. 3), S17. doi: 10.1186/1471-2458-11-S3-S17 CrossRefGoogle Scholar
  48. Imdad, A., & Bhutta, Z. A. (2011b). Effect of preventive zinc supplementation on linear growth in children under 5 years of age in developing countries: A meta-analysis of studies for input to the lives saved tool. BMC Public Health, 11(Suppl. 3), S22. doi: 10.1186/1471-2458-11-S3-S22 CrossRefGoogle Scholar
  49. Imdad, A., Yakoob, M. Y., & Bhutta, Z. A. (2011). The effect of folic acid, protein energy and multiple micronutrient supplements in pregnancy on stillbirths. BMC Public Health, 11(Suppl. 3), S4. doi: 10.1186/1471-2458-11-S3-S4 CrossRefGoogle Scholar
  50. Jain, A. K. (2011). Measuring the effect of fertility decline on the maternal mortality ratio. Studies in Family Planning, 42, 247–260.CrossRefGoogle Scholar
  51. Junhong, C. (2001). Prenatal sex determination and sex selective abortion in rural central China. Population and Development Review, 27, 259–282.CrossRefGoogle Scholar
  52. King, J. C. (2003). The risk of maternal nutritional depletion and poor outcomes increases in early or closely spaced pregnancies. Journal of Nutrition, 133, 1732S–1736S.Google Scholar
  53. Klasen, S., & Lamanna, F. (2009). The impact of gender inequality in education and employment on economic growth: New evidence for a panel of countries. Feminist Economics, 15(3), 91–132.CrossRefGoogle Scholar
  54. Knodel, J. (1977). Family limitation and the fertility transition: Evidence from the age patterns of fertility in Europe and Asia. Population Studies, 31, 219–249.CrossRefGoogle Scholar
  55. Knodel, J. (1997). The closing of the gender gap in schooling: The case of Thailand. Comparative Education, 33, 61–86.CrossRefGoogle Scholar
  56. Kögel, T. (2004). Did the association between fertility and female employment within OECD countries really change its sign? Journal of Population Economics, 17, 45–65.CrossRefGoogle Scholar
  57. Korzeniewicz, R. P., & Moran, T. P. (1997). World-economic trends in the distribution of income, 1965–1992. American Journal of Sociology, 102, 1000–1039.CrossRefGoogle Scholar
  58. Lee, R. (2003). The demographic transition: Three centuries of fundamental change. Journal of Economic Perspectives, 17, 167–190.Google Scholar
  59. Lee, R., & Mason, A. (2010). Fertility, human capital, and economic growth over the demographic transition. European Journal of Population, 26, 159–182.CrossRefGoogle Scholar
  60. London, B. (1992). School-enrollment rates and trends, gender, and fertility: A cross-national analysis. Sociology of Education, 65, 306–316.CrossRefGoogle Scholar
  61. Malhotra, A., Vanneman, R., & Kishor, S. (1995). Fertility, dimensions of patriarchy, and development in India. Population and Development Review, 21, 281–305.CrossRefGoogle Scholar
  62. Marquardt, D. W. (1970). Generalized inverses, ridge regression, biased linear estimation, and nonlinear estimation. Technometrics, 12, 591–612.CrossRefGoogle Scholar
  63. Mason, K. O. (1984). The status of women: A review of its relationships to fertility and mortality. New York, NY: Rockefeller Foundation.Google Scholar
  64. Mason, K. O. (1987). The impact of women’s social position on fertility in developing countries. Sociological Forum, 2, 718–745.CrossRefGoogle Scholar
  65. Mason, K. O. (1997). Gender and demographic change: What do we know? In G. W. Jones, R. M. Douglas, J. C. Caldwell, & R. M. D’Souza (Eds.), The continuing demographic transition (pp. 158–182). Oxford, UK: Clarendon Press.Google Scholar
  66. Matysiak, A., & Vignoli, D. (2008). Fécondité et travail des femmes: Une méta-analyse [Fertility and women’s employment: A meta-analysis]. European Journal of Population, 24, 363–384.CrossRefGoogle Scholar
  67. Mauldin, W. P. (1978). Patterns of fertility decline in developing countries, 1950–75. Studies in Family Planning, 9, 75–84.CrossRefGoogle Scholar
  68. Mauldin, W. P. (1982). The determinants of fertility decline in developing countries: An overview of the available empirical evidence. International Family Planning Perspectives, 8, 116–121.CrossRefGoogle Scholar
  69. Mauldin, W. P., & Segal, S. J. (1988). Prevalence of contraceptive use: Trends and issues. Studies in Family Planning, 19, 335–353.CrossRefGoogle Scholar
  70. McDonald, P. (2000). Gender equity in theories of fertility transition. Population and Development Review, 26, 427–439.CrossRefGoogle Scholar
  71. Measure DHS. (2011). Demographic and Health Surveys STAT compiler [Data file]. Retrieved from
  72. Merchant, K., & Martorell, R. (1988). Frequent reproductive cycling: Does it lead to nutritional depletion of mothers? Progress in Food and Nutrition Sciences, 12, 339–369.Google Scholar
  73. Muhuri, P. K., & Preston, S. H. (1991). Effects of family composition on mortality differentials by sex among children in Matlab, Bangladesh. Population and Development Review, 17, 415–434.CrossRefGoogle Scholar
  74. Neter, J., Wasserman, W., & Kutner, M. H. (1989). Applied linear regression models. Irwin, IL: McGraw-Hill.Google Scholar
  75. O’Brien, R. M. (2007). A caution regarding rules of thumb for variance inflation factors. Quality and Quantity, 41, 673–690.CrossRefGoogle Scholar
  76. Operations Research Group. (1980/1988). Family planning practices in India. Baroda, India: Operations Research Group.Google Scholar
  77. Pande, R. (2003). Selective gender differences in childhood nutrition and immunization in Rural India: The role of siblings. Demography, 40, 395–418.CrossRefGoogle Scholar
  78. Parashar, S. (2005). Moving beyond the mother-child dyad: Women’s education, child immunization, and the importance of context in rural India. Social Science & Medicine, 61, 989–1000.CrossRefGoogle Scholar
  79. Pebley, A., & Amin, S. (1991). The impact of a public health intervention on sex differentials in childhood mortality in rural Punjab, India. Health Transition Review, 1, 143–169.Google Scholar
  80. Presser, H. B. (1971). The timing of the first birth, female roles and black fertility. Milbank Memorial Fund Quarterly, 49, 329–359.CrossRefGoogle Scholar
  81. Registrar General of India. (1970–1975/1979–1981/1990/1991/1992). Sample registration system. New Delhi: Registrar General of India.Google Scholar
  82. Reher, D. S. (2011). Economic and social implications of the demographic transition. Population and Development Review, 37(Suppl.), 11–33.CrossRefGoogle Scholar
  83. Rosero-Bixby, L., Castro Martín, T., & Martín-García, T. (2009). Is Latin America starting to retreat from early and universal childbearing? Demographic Research, 20(article 9), 169–194. doi: 10.4054/DemRes.2009.20.9 CrossRefGoogle Scholar
  84. Ross, J. A., & Blanc, A. K. (2012). Why aren’t there more maternal deaths? A decomposition analysis. Maternal Child Health Journal, 16, 456–463.CrossRefGoogle Scholar
  85. Rutstein, S. O. (2000). Factors associated with trends in infant and child mortality in developing countries during the 1990s. Bulletin of the World Health Organization, 78, 1256–1270.Google Scholar
  86. Rutstein, S. O., & Rojas, G. (2006). Guide to DHS statistics. Calverton, MD: ORC Macro.Google Scholar
  87. Sanderson, S. K., & Dubrow, J. (2000). Fertility decline in the modern world and in the original demographic transition: Testing three theories with cross-national data. Population and Environment, 21, 511–537.CrossRefGoogle Scholar
  88. Sawyer, C. C. (2012). Child mortality estimation: Estimating sex differences in childhood mortality since the 1970s. PLoS Medicine, 9(8), e1001287. doi: 10.1371/journal.pmed.1001287 CrossRefGoogle Scholar
  89. Shen, C., & Williamson, J. B. (1997). Child mortality, women’s status, economic dependency, and state strength: A cross-national study of less-developed countries. Social Forces, 76, 667–694.Google Scholar
  90. Shen, C., & Williamson, J. B. (1999). Maternal mortality, women’s status, and economic dependency in less developed countries: A cross-national analysis. Social Science & Medicine, 49, 197–214.CrossRefGoogle Scholar
  91. Shen, C., & Williamson, J. B. (2001). Accounting for cross-national differences in infant mortality decline (1965–1991) among less developed countries: Effects of women’s status, economic dependency, and state strength. Social Indicators Research, 53, 257–288.CrossRefGoogle Scholar
  92. Sneeringer, S. E. (2009). Fertility transition in sub-Saharan Africa: A comparative analysis of cohort trends in 30 countries (DHS Comparative Reports No. 23). Calverton, MD: ICF Macro.Google Scholar
  93. Tsui, A. O., & Bogue, D. J. (1978). Declining world fertility: Trends, causes, and implications. Population Bulletin, 33(4), 2–56.Google Scholar
  94. UNICEF, Statistics and Monitoring. (2011). Multiple Indicator Cluster Surveys (MICS) customized statistical tables [Data file]. Retrieved from
  95. United Nations, Department of Economic and Social Affairs: Population Division. (2009). World population prospects 2008 [Data file]. Retrieved from
  96. Vella, S. (2005). Low fertility and female discrimination in South India: The puzzle of Salem district, Tamil Nadu. In C. Z. Guilmoto & S. I. Rajan (Eds.), Fertility transition in South India (pp. 248–281). New Delhi, India: Sage Publications.Google Scholar
  97. Weinberger, M. B., Lloyd, C., & Blanc, A. K. (1989). Women’s education and fertility: A decade of change in four Latin American countries. International Family Planning Perspectives, 15, 4–14.CrossRefGoogle Scholar
  98. Westoff, C. F. (2003). Trends in marriage and early childbearing in developing countries (DHS Comparative Reports No. 5). Calverton, MD: ORC Macro.Google Scholar
  99. Willis, R. J. (1973). A new approach to the economic theory of fertility behavior. The Journal of Political Economy, 81, S14–S64.CrossRefGoogle Scholar
  100. Wilson, C. (2001). On the scale of global demographic convergence 1950–2000. Population and Development Review, 27, 155–171.CrossRefGoogle Scholar
  101. Winkvist, A., Rasmussen, K. M., & Habicht, J. P. (1992). A new definition of maternal depletion syndrome. American Journal of Public Health, 82, 691–694.CrossRefGoogle Scholar
  102. World Bank. (2011). World development indicators [Data file]. Retrieved from
  103. World Values Survey Association. (2011). World values survey. Retrieved from
  104. Zeng, Y., Tu, P., Gu, B., Xu, Y., Li, B., & Li, Y. (1993). An analysis of the cause and implications of recent increase in the sex ratio at birth in China. Population and Development Review, 19, 283–302.CrossRefGoogle Scholar

Copyright information

© Population Association of America 2014

Authors and Affiliations

  • Kathryn M. Yount
    • 1
    Email author
  • Sarah Zureick-Brown
    • 2
  • Nafisa Halim
    • 3
  • Kayla LaVilla
    • 2
  1. 1.Asa Griggs Candler Chair of Global Health, Hubert Department of Global Health and Department of SociologyEmory UniversityAtlantaUSA
  2. 2.Department of SociologyEmory UniversityAtlantaUSA
  3. 3.Department of International HealthBoston UniversityBostonUSA

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